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Am J Prev Med. 2015 Sep;49(3):354-61. doi: 10.1016/j.amepre.2015.02.001.

Adverse Childhood Experiences: Expanding the Concept of Adversity.

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Department of Family Medicine and Community Health, University of Pennsylvania; Center for Public Health Initiatives, University of Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania. Electronic address:
Department of Epidemiology and Biostatistics, University of Pennsylvania; Violence Prevention Initiative, Center for Injury Research Prevention.
Department of Pediatrics, The Children's Hospital of Philadelphia.
Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.
Robert Wood Johnson Foundation, Princeton, New Jersey.
Philadelphia Health Management Corporation, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.
Department of Pediatrics, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, Pennsylvania.
Violence Prevention Initiative, Center for Injury Research Prevention; Department of Emergency Medicine, The Children's Hospital of Philadelphia.



Current knowledge of Adverse Childhood Experiences (ACEs) relies on data predominantly collected from white, middle- / upper-middle-class participants and focuses on experiences within the home. Using a more socioeconomically and racially diverse urban population, Conventional and Expanded (community-level) ACEs were measured to help understand whether Conventional ACEs alone can sufficiently measure adversity, particularly among various subgroups.


Participants from a previous large, representative, community-based health survey in Southeast Pennsylvania who were aged ≥18 years were contacted between November 2012 and January 2013 to complete another phone survey measuring ACEs. Ordinal logistic regression models were used to test associations between Conventional and Expanded ACEs scores and demographic characteristics. Analysis was conducted in 2013 and 2014.


Of 1,784 respondents, 72.9% had at least one Conventional ACE, 63.4% at least one Expanded ACE, and 49.3% experienced both. A total of 13.9% experienced only Expanded ACEs and would have gone unrecognized if only Conventional ACEs were assessed. Certain demographic characteristics were associated with higher risk for Conventional ACEs but were not predictive of Expanded ACEs, and vice versa. Few adversities were associated with both Conventional and Expanded ACEs.


To more accurately represent the level of adversity experienced across various sociodemographic groups, these data support extending the Conventional ACEs measure.

[Indexed for MEDLINE]

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